New denial appeal and hearing rights language requirements in Oregon Workers’ Compensation
As a reminder, the Oregon Workers’ Compensation Board recently revised Oregon Administrative Rule (OAR) 438-005-0055 to reflect changes to the required denial and hearing rights language that must issue with any denial. As always, all notices of denial must specify the factual and legal reasons for the denial and, effective November 1, 2024, the denial must also contain the below language, in prominent or bold-face type; formatted as below:
IF YOU DISAGREE with this DENIAL, you must file an APPEAL WITHIN 60 DAYS after the mailing date of the DENIAL by doing one of the following:
(1) MAILING a letter to the Workers’ Compensation Board, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280;
(2) Sending an E-MAIL to: ;
(3) Sending a FAX to: 503-373-1600; or
(4) PHYSICAL DELIVERY of a letter to a Workers’ Compensation Board Office in Salem, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280, or Portland, 16760 SW Upper Boones Ferry Road, Suite 220, Portland, OR 97224-7696.
Your letter, email, or fax, should include: (1) you want a hearing; (2) your address; (3) the date of the denial; (4) the claim number; and (5) the date of your injury or exposure, if you know the date. If the Workers’ Compensation Board receives your appeal more than 60 days after the mailing date of this denial, you may have to prove you filed the appeal within 60 days.
IF YOU DO NOT APPEAL WITHIN 60 DAYS of the mailing date of this denial, YOU WILL LOSE ANY RIGHT you may have to compensation. The only exception is if you can show good cause for delay beyond the 60 days. After 180 days, all of your rights will be lost.
By law, your appeal cannot affect your employment.
You may request an examination by a physician selected by the Workers’ Compensation Division at no cost to you if: (1) you timely request a hearing on a denial of compensability; (2) the denial is based on one or more medical reports of insurer or self-insured employer requested medical examinations; and (3) your attending physician does not agree with or did not comment on the report(s).
You may be REPRESENTED BY AN ATTORNEY of your choice at NO COST TO YOU for attorney fees.
If you have questions you may contact:
(1) The Ombuds Office for Oregon Workers toll free at 1-800-927-1271, https://www.oregon.gov/dcbs/OOW.
(2) The Workers’ Compensation Board toll free at 877-311-8061, https://www.oregon.gov/wcb.
(3) The Workers’ Compensation Division toll free at 1-800-452-0288, https://wcd.oregon.gov.
Alternatively, if the employer/insurer/administrator intends to deny a claim under ORS 656.262(15) because of a worker’s failure to cooperate in the investigation of the claim (also known as a “non-cooperation denial”), the notice of denial must contain the below language, in prominent or bold-face type, formatted as follows:
IF YOU DISAGREE with this DENIAL, you must file an APPEAL WITHIN 60 DAYS after the mailing date of the DENIAL by doing one of the following:
(1) MAILING a letter to the Workers’ Compensation Board, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280;
(2) Sending an E-MAIL to: ;
(3) Sending a FAX to: 503-373-1600; or
(4) PHYSICAL DELIVERY of a letter to a Workers’ Compensation Board Office in Salem, 2601 25th Street SE, Suite 150, Salem, Oregon 97302-1280, or Portland, 16760 SW Upper Boones Ferry Road, Suite 220, Portland, OR 97224-7696.
Your letter, email, or fax should include: (1) that you want an EXPEDITED hearing; (2) your address; (3) the date of the denial; (4) the claim number; and (5) the date of your injury or exposure, if you know the date. If the Workers’ Compensation Board receives your appeal more than 60 days after the mailing date of this denial, you may have to prove you filed the appeal within 60 days.
IF YOU DO NOT APPEAL WITHIN 60 DAYS of the mailing date of this denial, YOU WILL LOSE ANY RIGHT you may have to compensation. The only exception is if you can show good cause for delay beyond the 60 days. After 180 days, all of your rights will be lost.
You will receive an EXPEDITED hearing within 30 days.
By law, your appeal cannot affect your employment.
You may be REPRESENTED BY AN ATTORNEY of your choice at NO COST TO YOU for attorney fees.
If you have questions you may contact:
(1) The Ombuds Office for Oregon Workers toll free at 1-800-927-1271, https://www.oregon.gov/dcbs/OOW.
(2) The Workers’ Compensation Board toll free at 877-311-8061, https://www.oregon.gov/wcb.
(3) The Workers’ Compensation Division toll free at 1-800-452-0288, https://wcd.oregon.gov.
Thank you for entrusting SBH Legal with your Oregon workers’ compensation needs. If you have any questions regarding your Oregon claim processing analyses, recommendations, and/or any other Oregon workers’ compensation topics, please contact me at 503-595-6109 or .
Posted by Andrew Evenson.
